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Melanie Cole (Guest): By understanding what blood pressure is and knowing your numbers, you can reduce your risk of other serious diseases. My guest today is Dr. Joseph Kummer. He’s a cardiologist at Bryan Heart. Welcome to the show, Dr. Kummer. Let’s start with a little physiology lesson. What is blood pressure?

Dr. Joseph Kummer (Guest): Well, it’s a good question, Melanie. I appreciate you letting me talk today. Blood pressure simply is the pressure inside the arteries in your body. The heart primarily generates pressure. It squeezes, it pumps the blood forward and the harder is squeezes, the harder and higher the pressure is. That blood goes out to the aorta, goes out to every other artery in the body. The whole idea for that is that that pressure pushes the blood forward enough to each and every organ in the entire body. There’s a certain healthy level, kind of like the oil pressure in your car. You may have seen that oil pressure light come on if it gets too low of pressure and that’s very, very dangerous. Your car can’t run that way. Same thing if your blood pressure is too high or too low. Either one can be very harmful to the body. So, the whole body is designed to operate--the brain, the kidneys, the liver--at a certain level of pressure of blood flowing through it.

Melanie Cole: So, what are those two numbers that people always hear about: systolic and diastolic?

Dr. Joseph Kummer: Well, the systolic number, we generally say is the upper number. When you hear your blood pressure, the diastolic is the lower number. There’s always pressure in the arteries. There’s always pressure in the whole system. When the heart squeezes, then the highest amount of pressure at the maximum squeezing is the systolic. So, that’s as high as it gets. When the heart relaxes, it’s filling with blood, getting ready for the next beat but there still is pressure throughout the whole system. So, basically, it’s just the peak and the trough of where that blood pressure fluctuates.

Melanie Cole: So, how often or when should people even get this checked?

Dr. Joseph Kummer: That’s a good question. Probably one of the more important things to really keep in mind is that we talk about high blood pressure as the silent killer. If you have a cold or a runny nose, you know it. You know. If you have a fever, you can feel it. High blood pressure, though,, is very, very dangerous. It can be very harmful but, a lot of times, people have no idea that they have high blood pressure because they often don’t feel the damage is being done. And so, the only way to know, the majority of times, is to get it checked. It never hurts to get the blood pressure checked. You just put a little cuff, a little thing around your arm and we fill up that with pressure. It doesn’t do any harm at all. It just takes a very brief time to do it. And, it can give a whole lot of information and, a lot of times, your doctor will see you routinely in the office and just for an annual physical or you go to the doctor or the dentist, wherever they check the blood pressure. A lot of times people are pretty surprised and say, “Wow, I had no idea my blood pressure was that high.” Very often, we’ll find that it is very high, even dangerously high and they feel fine. So, that’s one of the really important things that you need to get it checked because, even if you feel good, you still could have high blood pressure.

Melanie Cole: What are the numbers you want us to be looking for?

Dr. Joseph Kummer: It’s a very good question. That’s something that’s kind of dependent upon the patient, the person, to some extent individually. Most people or pretty much everybody, we want to see the blood pressure generally less than 150/90. Most people we want less than 140/90. Now, there’s a lot of debate about what the perfect numbers are for each individual. If you have some other illnesses like bad kidneys, if you have diabetes, heart disease, we might be more aggressive. Your doctor very well might want it a little bit lower. We generally say “normal” blood pressure is 120/80. That’s usually good for most people. If it’s a little bit higher, and that depends upon a lot of other illnesses and your age factors into that, too. A lot of times, your blood pressure tends to get a little higher as you get older. So, those are the general numbers but if you ever see it above 140/90, that’s certainly a cause for concern and something you should talk about with your doctor.

Melanie Cole: If you have one high blood pressure reading, does that mean you have high blood pressure?

Dr. Joseph Kummer: Absolutely not, because the blood pressure is something that’s always changing. There are times when your blood pressure should be higher, like when you’re exercising. It’s kind of the same thing, you know, with your heart rate. You know, we have a lot of heart rate monitors these days. When you can see when you’re on the treadmill, you know, your heart rate might start at 70 and then, you get on the treadmill and it goes up to 120. That’s a normal reaction because your body needs more blood supply, so you need more heart beats but you also need a little more blood pressure. So, in a certain situation in life when you’re exercising, your blood pressure is going to go up a little bit. Now, the blood pressure itself changes all the time throughout the course of the day due to physical exertion, due to stress, and then, there’s just the natural fluctuation based upon hormones and changes throughout the course of the day. So, it’s really important to check your blood pressure multiple times. As a matter of fact, we almost never try to make a diagnosis of high blood pressure based upon any one particular moment in time. Also, just checking it sometimes in the morning, sometimes in the evening, can be helpful because there are different things that influence that as well. We usually recommend, as a matter of fact, we pretty much always recommend the perfect way to check blood pressure is when you’ve been sitting at rest for several minutes. That’s a little bit ironic because, admittedly even doctors, we often kind of bring patients to the clinic, they have to sit down here, get up walk over here, go over and check out this, bring you back to a room and check your blood pressure after you’ve been running around and moving from one room to another. A lot of times, we see that blood pressure higher at that moment because you’ve not been sitting still for several minutes. So, often we’ll have you recheck it a few minutes later after you’ve been sitting a little more relaxed because that’s considered to be more of an accurate reflection of your true blood pressure.

Melanie Cole: Do you want people to buy a blood pressure cuff to keep at their home and check it on a regular basis?

Dr. Joseph Kummer: Well, it’s certainly not harmful. Again, checking it doesn’t do any harm. The blood pressure cuffs do cost some money. They’re often about $40-50. They are very simple to use and, in general, they work quite well. But, I really do encourage most of my patients with high blood pressure to do that just for that purpose because if they drove in here and they’ve been fighting traffic and they’re rushing up the stairs to get here, sometimes we don’t get the most accurate reading. We call that, “White Coat Hypertension”. The whole idea is that they see a white coat like a doctor, you get a little bit anxious and, of course, if you’ve been rushing to the office, then sometimes the readings we see in the office aren’t quite as accurate. But, if you have a home blood pressure cuff, you can check it frequently. You can check it at different times of the day. You can check it before you go to bed, first thing in the morning. Then, you get a better, more accurate assessment of what the blood pressure runs kind of on average. Some people come into my office and their blood pressure is very, very high but then, they bring in the list and they have twenty readings from the last three months, all of which are perfect normal at home. So, that’s something that can be very, very beneficial because if I treat that reading that I see in the office and that’s not an accurate representation of their average blood pressure, their blood pressure might be too low if I put them on a bunch of medication for that. So, I think that gives a lot of helpful information and it definitely is much better because it’s not just one moment in time, like when you’re in the doctor’s office. It tells you more or more so what’s been going on with your blood pressure in the last month, the last three months; what time it was in the morning, how it was in the evening, etc.

Melanie Cole: Dr. Kummer, before we get into medications, because blood pressure is so dynamic, if people are exercising and they see that systolic--that high number--jump up, when do you worry about that? And does the diastolic--that lower number--should that be moving around?

Dr. Joseph Kummer: Well, the systolic and diastolic both increase with exercise. We don’t like to see it get extremely high. Now, exactly how high that is, is kind of a difficult number because we don’t know what the perfect number is when you’re exercising. We do know if we get readings above 180, may be certainly above 200, that’s probably a little more than we’re generally comfortable seeing. It also depends upon how aggressively we are working out, too. That might just be more of a sign that you’re working out a little bit too hard. Maybe you need to back off a little on your exertional level. Same thing with the diastolic, too. The diastolic often can be increased with exercise. But, the most important thing is, what is your blood pressure doing a little bit more so with rest? What is it kind of doing the majority of the time? Because, again, it is supposed to increase to some extent. What often is very helpful is to see what your blood pressure is doing ten minutes, thirty minutes, an hour after you exercise. If it goes up when you’re exercising, a lot of that is what it’s supposed to do. But at the same time, it’s supposed to come down pretty quickly after you’re exercising too.

Melanie Cole: So, speak about treatment now--the first line of defense. And then, I’d like you to even get into lifestyle and home remedies. But, what’s the first line if you discover that somebody has high blood pressure? Do you put them on medication right away? What do you do?

Dr. Joseph Kummer: The number one best thing you can do to treat high blood pressure is to do things that are healthy for your body, in general. A lot of things that you probably should be doing anyway. We try not to jump to medication as a first line. There are several things you can do with lifestyle and, of course, every individual is different but salt is one of the big things we really kind of look for with blood pressure because the body uses salt to raise the blood pressure. The body holds onto salt. So, if you could limit your salt intake, a lot of times that can help to lower the blood pressure. That has nothing to do with medications at all. It’s a very natural, healthy thing that you can do that is probably the best thing first and foremost. Now, most people with high blood pressure can bring the blood pressure down dramatically with limiting their salt intake but it usually helps at least to some extent. And about 80% of our salt intake in this county is in processed foods. So, we consume a lot more salt than we’re supposed to. Salt tastes good; people like it. It sells products. So, whether you’re in a restaurant, or, a lot of the stuff you buy in the grocery store, there’s tons of salt added on to it because it sells the product. But, that’s not healthy for us. So, trying to get rid of a lot of that sodium or salt intake is very, very important. Exercise is extremely important for almost everything in your body. It’s very, very good for the heart. The more you exercise, even though your blood pressure goes up again when you’re exercising, in the long run, your blood pressure does decrease because it’s healthier. Your body’s more conditioned. So, it doesn’t need as much of the blood pressure to help it get by. It adjusts to the things it needs to better. So, limiting your salt intake and exercising more are two very important things for lowering that don’t have anything to do with medication. If you’re overweight, controlling your weight, losing weight, can be very helpful because the more fat you have in your body, the more weight you’re carrying, that tends to drive the blood pressure up as well.

Melanie Cole: So then, when does it get to medication? We don’t have a lot of time left but then when does it get to medication? Give us your best advice for people when it regards to blood pressure.

Dr. Joseph Kummer: Sure. Basically, we like to use medication when diet and lifestyle changes have not made a difference. Cutting back on smoking is another very important thing. Smoking raises blood pressure, too. But, if we try that for a few months and your blood pressure has not come down to a healthy level, then there are several medications. I won’t go into those because there are many different options and there are a lot of very good options. One thing I want to encourage people is that if they try a medication and they have some adverse reaction to it, keep in mind there are many, many medications we have now for blood pressure. We can almost always find a healthy fit for an individual without the side effects. Most people with high blood pressure do need to be on at least one medication. In fact, most need to be on two or more to get it to a healthy level. But, again, there are several good options for medication. There are ones that are tolerated very well. You just have to choose the right one.

Melanie Cole: Tell us about your team at Bryan Heart. Why listeners should come there for their care.

Dr. Joseph Kummer: We do pretty much everything that you can think of for the heart. We’re experts at treating high blood pressure, cholesterol, heart failure, heart attacks. We have a very advanced program for treating everything with the heart. We do the first line which is encouraging people to eat healthy, to exercise, to quit smoking, all the way to the point of open-heart surgery, putting people on machines to help their heart pump--very advanced things, too. We have an excellent team here. We have a lot of specialists. We have general cardiologists. We have an outstanding hospital with an excellent nursing staff, too. The vast majority of our patients really enjoy the experience. They enjoy the healthcare. Our evaluations from our patients and according to other third parties have really given us very high ratings. We tend to excel in almost every area because we really put a lot of effort into making sure that we’re doing a good thorough job and making sure a patient is happy and just trying to keep a very positive environment so that everyone’s on the same page.

Melanie Cole: Thank you so much, Dr. Kummer. What an important lesson you’ve given us today. If you’re concerned about your blood pressure, schedule an appointment with Bryan Heart Lipid and Prevention Clinic by calling (402) 483-3333. That’s (402) 483-3333. You’re listening to Bryan Health Radio. For more information you can go to bryanheart.com. That’s bryanheart.com. This is Melanie Cole. Thanks so much for listening.